Before The Crash

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Before The Crash

• Kathy Strotmeyer
• PA American Academy of Pediatrics
• Pittsburgh, PA
• 412.885.0266
• strotmeyer_at_earthlink.net

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Todays Objective

• Understand each others goals at the scene of a
  school bus crash.
• Increase levels of communication.
• Identify areas of cooperation to enhance
  effectiveness
  
  
  
  
  
  
  
  
  
  

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EMS Roles Goals

• Provide patient care
• Medically fragile students
• Locate patients accountability
• Organize the scene
• Remove patients from scene

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Transportation Roles Goals

• Identification Control students
• Facilitate safety of students
• Collect crash data
• Cooperate with emergency responders

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Tunnel Vision
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Accountability

• Rosters
• Attendance
• Tracking

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Rosters

• Name of student
• Parent Contact phone number
• Pertinent medical history (disabilities,illness,
  allergies etc.)
• Privacy laws are voided during an Mass Casualty
  Incident

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Attendance

• Who is on the bus that day?
• Who is on the bus at the time?
• Attendance information at school accessible?
• Numbers on bus when all else fails.

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Pre-Planning

• Definitions
• Command
• Information Management
• Logistics
• Communications

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Definition of Pre-Planning

• Preparation made by emergency service
  personnel for handling a specific incident which
  has not occurred so those personnel can do an
  intelligent and effective job in an organized
  manner

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Preplanning is crucial

• In an actual incident, size up may be difficult
• Accessibility may be poor (Cattle Chutes)
• Vapor cloud may obstruct vision

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Preplanning is crucial

• Decisions must be made under many difficult
  situations
• Decisions made within a limited time
• Decisions made under duress due to possible
  impending severity of the incident

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Preplanning is crucial

• Preplans must be practiced and reviewed
• Changes can be made
• Personnel can become familiar with the plan

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School Bus Pre-Planning

• Medical information in the hands of the bus
  personnel.
• Training
• Equipment
• Emergency evacuations
• Lifts carries
• Students
• Crash procedures

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Steps to Pre-Planning

• Who should attend?
• Police, EMS, Fire, Schools etc.
• What are goals of each at the scene?
• Expectations, assumptions?
• Logistical concerns
• Where do parents report
• Where will children be takenetc.
• Who handles the media?
• Role of Liaison
• Communicate and compromise when possible

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Command

• Unified Command
• School, Transportation Contractor, Police, EMS,
  Fire
• EMS commands until patients removed, law
  enforcement commands during investigation

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Unified Command
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Unified Command

• Multiple rescue / EMS companies
• Fire Departments
• Police agencies
• NHTSA, NTSB
• DER, EPA
• Haz Mat Teams
• PEMA, Local EMA
• Local Government
• DPW

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Role of Transporters in Unified Command

• Verification and transfer of student
  information.
• Student custody/tracking.
• Custody Vs. Care
• Establish information center for parent and
  school connection. Red Cross
• Data collection for future liabilities.

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Incident Commander

• Assess incident
• Develops appropriate EMS branch assignments
• Requests additional resources
• Work with other agencies

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Triage Officer

• Establish Triage area
• Assign EMS personnel to triage and tag pts
• Ensure all pts are seen and triaged
• Assist transportation officer

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TRIAGE TAGS

• Red
• Yellow
• Green
• White
• Black

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Treatment Officer

• Establish pt collection/treatment areas
• Re-triage pts as necessary
• Notify transport officer of pts ready for
  transport

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Transportation Officer

• Obtains status from local hospitals
• Assists with choosing staging area
• Assigns pts to transport vehicle
• Records number of pts and transport times and
  location

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Staging Officer

• Keeps track of apparatus and personnel in staging
  area
• Send needed unit or personnel to area requesting
  them
• Sets up an equipment staging area

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Extrication Officer

• Works with triage to extricate priority pts
  first
• Works with fire department personnel for hazard
  mitigation
• Extricates pts in a timely and safe manor

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Other UC Functions

• Logistics
• Finance
• Liaison
• Planning
• Safety
• Information
• Communications

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Logistics

• Vehicles to transport non-injured or ambulatory
  injured patients
• School District policy regarding uninjured
  student release
• Access egress to and from scene

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Communication

• School or contractor and EMS personnel
• Parents
• Media practice drill
• Identify Decision Makers
• Crash Site Liaison

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Information Management

• Public Information Officer
• Located away from scene if possible
• Parent communications
• Student Tracking information
• Parent/Guardian verifications releases

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Family on the Scene

• Family and friends on scene
• Calms patients ?
• Try and utilize the media to have parents go to a
  different location for information
• Who controls the family members?

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Bystanders

• Bystanders Safety
• Remember Some are truly trying to help
• Rubber-neckers
• Patient confidentiality and modesty

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Training

• Practice drill mock disaster
• Review Modification of preplan
• Personnel become familiar with plan and student
  disabilities
• Understand Roles involved theirs and others

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School Bus Personnel Training

• Classroom student training
• Bus drills with students including evacuation
  especially for special needs students
• Scenario training
• MCI events
• Rodeo training
• Accident Procedures

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School Bus Access

• Doors
• Emergency Doors
• Side or rear Windows
• Windshield
• Roof access
• Sides
• Floors

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Bus Crash Injuries

• Deceleration type injuries
• There may be no seat belts
• Crews may run out of immobilization equipment

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Height of Patients

• Difficult to extricate patient fears
• Patients feet may be at the 4 level and their
  head at the 8 level
• Wheelchairs, Child Safety Seats

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Flow of Patient Traffic

• Tunneling into patients if possible
• Doors - front may have to be removed to fit
  backboards
• Enlarge doors
• Enlarge windows
• Side wall openings
• Roof openings

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Widening the Rear Door
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Removing Side Windows
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Side Openings
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Removal of Patients
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• You've done this a thousand times.
• You've carefully thought out all the angles.
• It comes naturally to you.
• You know what you're doing, its what you've been
  trained to do.
• Nothing could possibly go wrong, right ?

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WRONG.
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Summary Questions